Ultrasound treatment instrument

ABSTRACT

With respect to a forceps type treatment instrument including an ultrasound probe that protrudes from a treatment instrument main body at a position separated to a distal end side from a shaft portion, and a jaw that is displaceable between a closed state and an opened state by being linked with swing action of an clamp arm in a position separated to a distal end side from the shaft portion, stoppers are extendedly provided toward a clamp arm side from a treatment instrument main body side in a state in which edge portions at a distal end side are set to located at a distal end side from a locus of a proximal end of the jaw, and entry of a living body into a gap of the treatment instrument main body and the clamp arm is restricted.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.13/897,810, filed May 20, 2013, which is a continuation application ofPCT/JP2012/077784 filed on Oct. 26, 2012 and claims benefit of U.S.Provisional Patent Application No. 61/551,676 filed in the U.S.A. onOct. 26, 2011, the entire contents of which are incorporated herein bythis reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an ultrasound treatment instrument thatperforms treatment such as dissection, ablation, or coagulation ofliving tissue by using ultrasound.

2. Description of the Related Art

Conventionally, as a treatment instrument for performing surgicaltreatment, an ultrasound treatment instrument has been known. Anultrasound treatment instrument is capable of performing treatment suchas dissection, ablation, or coagulation of living tissue, for example,by transmitting ultrasound vibration to the living tissue, or mergingultrasound vibration and a high-frequency current and transmitting theultrasound vibration and the high-frequency current.

In particular, as an ultrasound treatment instrument favorable for fineand delicate surgical treatment such as thyroidectomy, among ultrasoundtreatment instruments, a forceps type (scissors type) ultrasoundtreatment instrument is disclosed in for example, Japanese PatentApplication Laid-Open Publication No. 2009-514566. The forceps typeultrasound treatment instrument has a treatment instrument main body(handle assembly) containing a waveguide (transmission rod) thattransmits ultrasound vibration to a distal end side from a proximal endside, and a clamp arm that is pivotally supported swingably at thetreatment instrument main body via a shaft portion. From a distal end ofthe treatment instrument main body, an ultrasound probe (blade) that isa distal end portion of the waveguide is protruded. A bent portion foravoiding interference with the treatment instrument main body isprovided at a distal end side of the clamp arm that intersects thetreatment instrument main body via the shaft portion. A jaw (clampmember) for sandwiching living tissue between the jaw and the ultrasoundprobe is provided at a distal end side from the bent portion. Further,the jaw is provided with a pad formed from a resin or the like, in aregion contactable with the ultrasound probe.

SUMMARY OF THE INVENTION

An ultrasound treatment instrument according to one aspect of thepresent invention includes a treatment instrument main body, a clamp armthat is pivotally supported swingably at the treatment instrument mainbody via a shaft portion, an ultrasound probe that protrudes from thetreatment instrument main body in a position separated to a distal endside from the shaft portion, a base that is provided at the clamp arm ina position separated to a distal end side from the shaft portion, anddisplaces between a closed state being in close proximity to theultrasound probe and an opened state separated from the ultrasound probeby being linked with a swing action of the clamp arm, a jaw that issupported swingably around an axis extending in a width direction of thebase to extend in a longitudinal direction of the base, and has aproximal end portion located at a proximal end side from the distal endportion of the base to form a space between the proximal end portion andthe base, stoppers that are provided toward side portions of the jawfrom the treatment instrument main body, and restrict entry of a livingbody into a gap of the treatment instrument main body and the clamp armbetween the proximal end portion of the jaw and the shaft portion, andoperation portions that cause the treatment instrument main body and theclamp arm to move relatively from a closed state to an opened state sothat edge portions at distal end sides of the stoppers are located at adistal end side from the proximal end portion of the jaw.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a configurational view of an ultrasound surgery apparatus;

FIG. 2 is a side view of an ultrasound treatment instrument;

FIG. 3 is a vertical sectional view of the ultrasound treatmentinstrument;

FIG. 4 is a plan view showing an opposing surface to a jaw, of anultrasound probe;

FIG. 5 is a plan view showing an opposing surface to the ultrasoundprobe, of the jaw;

FIG. 6 is a side view of the jaw;

FIG. 7 is a sectional view taken along the VII-VII line of FIG. 1;

FIG. 8 is a side view showing a distal end portion of the ultrasoundtreatment instrument in a state in which a treatment section is opened;

FIG. 9 is a side view showing a distal end portion of the ultrasoundtreatment instrument in a state in which the treatment section isclosed;

FIG. 10 is a perspective view of the distal end portion of theultrasound treatment instrument in the state in which the treatmentsection is opened, seen from an ultrasound probe side;

FIG. 11 is a perspective view showing the ultrasound treatmentinstrument of FIG. 10 in a state in which a part of a sheath memberconfiguring a sheath is removed;

FIG. 12 is a perspective view of the distal end portion of theultrasound treatment instrument in the state in which the treatmentsection is closed, seen from the ultrasound probe side;

FIG. 13 is a perspective view of the distal end portion of theultrasound treatment instrument in the state in which the treatmentsection is closed, seen from a jaw side;

FIG. 14 is a perspective view of a stopper member;

FIG. 15 is a plan view of the stopper member;

FIG. 16 is a sectional view taken along the XVI-XVI line of FIG. 15;

FIG. 17 is a sectional view showing a modification of the stoppermember;

FIG. 18 is a perspective view showing the modification of the stoppermember;

FIG. 19 is a side view showing a modification of the distal end portionof the ultrasound treatment instrument;

FIG. 20 is a side view showing the distal end portion of the ultrasoundtreatment instrument in the state in which the treatment section isopened;

FIG. 21 is a side view showing the distal end portion of the ultrasoundtreatment instrument in the state in which the treatment section isclosed;

FIG. 22 is a side view showing the distal end portion of the ultrasoundtreatment instrument in a state in which a part of the sheath memberconfiguring the sheath is removed;

FIG. 23 is a side view showing the distal end portion of the ultrasoundtreatment instrument in a state in which the treatment section is openedto a fully opened position; and

FIG. 24 is a plan view showing the sheath member.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

As shown in FIG. 1, an ultrasound surgical apparatus 1 that is a medicalapparatus according to a first embodiment of the present invention isconfigured by including an ultrasound transducer 5, an output controlapparatus 6 to which the ultrasound transducer 5 is connected, and atreatment instrument 7 that functions as an ultrasound treatmentinstrument by having a distal end portion of the ultrasound transducer 5connected thereto.

The ultrasound transducer 5 has an ultrasound transducer 11 contained ina transducer cover 10 that is formed into a substantially cylindricalshape. In the present embodiment, the ultrasound transducer 11 isconfigured by, for example, a plurality of piezoelectric elements 11 aeach formed into a ring shape being arranged in a long axis direction ofthe transducer cover 10. Further, a proximal end portion of a horn 12that performs amplitude expansion of ultrasound vibration is connectedto a distal end portion of the ultrasound transducer 11. A distal endportion 12 a of the horn 12 is protruded to an outside via a connectorportion 10 a that is formed at a distal end portion of the transducercover.

A cable 13 is extended from a proximal end portion of the transducercover 10, and the ultrasound transducer 5 is connected to the outputcontrol apparatus 6 via the cable 13.

A mode for supplying at least any one of a drive signal for ultrasoundoutput and a drive signal for high-frequency current output to theultrasound transducer 5 is set in the output control apparatus 6. Morespecifically, three output modes that are, for example, an ultrasoundoutput mode, a high-frequency current output mode and a simultaneousoutput mode of ultrasound and high-frequency current are set in theoutput control apparatus 6. In order to perform selection or the like ofthe output modes, various operation buttons 15 are placed on the outputcontrol apparatus 6. Further, display apparatuses 16 for displaying aselection state of the output mode, various output values and the likeare placed on the output control apparatus 6. Output setting of therespective modes can be performed in a touch panel manner on the displayapparatuses 16. Alternatively, setting can be changed with buttons notillustrated. Further, a foot switch 17 for turning on or off the outputof a drive signal corresponding to the output mode is connected to theoutput control apparatus 6 via a cable 17 a.

The treatment instrument 7 is configured by a forceps type (scissorstype) treatment instrument having a treatment instrument main body 20containing a waveguide 51 (see FIG. 3) that transmits ultrasoundvibration to a distal end side from a proximal end side, and a clamp arm21 that is pivotally supported swingably (rotatably) at the treatmentinstrument main body 20 via a shaft portion 22.

For example, as shown in FIGS. 2 and 3, the treatment instrument mainbody 20 is configured by having a housing 25 formed into a substantiallyconical shape, and a sheath 26 held by the housing 25.

The housing 25 is configured by, for example, housing members 27 a and27 b composed of a pair of resin molded products laterally divided beingjoined to each other by snap-fitting, press-fitting, bonding, adhesion,welding or mechanical means. A connector receiving portion 25 a fordetachably connecting the connector portion 10 a of the ultrasoundtransducer 5 is opened, in a proximal end portion of the housing 25.

Further, in a proximal portion side of the housing 25, a first fingerrest portion 28 formed into a ring shape is integrally formed in aposition that is offset from a center axis O of the housing 25.

Further, two switch buttons 29 and 30 are provided on a front edgeportion of the first finger rest portion 28. The switch buttons 29 and30 are placed at a position to which a forefinger (and a middle finger)of a surgeon or the like is faced in a state in which the surgeon or thelike inserts the middle finger and a ring finger, or the ring finger anda fifth finger into the first finger rest portion 28, for example. Theswitch button 29 is a switch button for turning on or off output of thedrive signal corresponding to an output mode, for example. The switchbutton 30 is a switch for changing an output value of the ultrasoundvibration or the high-frequency current, for example. As shown in FIG.3, proximal portions of the switch buttons 29 and 30 are providedconnectively to a control board 31 placed in the housing 25. Further, aflexible board 32 is provided extendedly from the control board 31, andthe flexible board 32 is connected to the connector receiving portion 25a. Thereby, operation signals to the switch buttons 29 and 30 aretransmitted to the output control apparatus 6 via the connectorreceiving portion 25 a. Subsequently, the operation signals aretransmitted to the output control apparatus 6, and thereby the surgeonor the like also can perform an on/off operation of output of the drivesignal at a hand side without operating the foot switch 17 or the like.

The sheath 26 is configured by having a first sheath 36 that is mainlyinserted through an inside of the housing 25, and a second sheath 37that is connected to a distal end portion of the first sheath 36 andextends to an outside of the housing 25.

The first sheath 36 is configured by, for example, a substantiallycylindrical member formed by a pair of sheath members 41 a and 41 b thatare vertically divided being joined to each other by snap-fitting,press-fitting, bonding, adhesion, welding or mechanical means. Further,the second sheath 37 is configured by, for example, a substantiallycylindrical member formed by a pair of sheath members 42 a and 42 b thatare laterally divided being joined to each other by snap-fitting,press-fitting, boning, adhesion, welding or mechanical means. The firstand the second sheaths 36 and 37 are connected by, for example, an outerperiphery of a distal end portion of the second sheath 37 being fittedonto an inner periphery of the distal end portion of the first sheath36, and configure the long continuous sheath 26. Inside the sheath 26,the waveguide 51 formed from a conductive metal is held via an elasticmember (not illustrated) such as a rubber ring or a plastic member, or aflange formed by a diameter of a part of the waveguide being enlarged.

In the housing 25, a proximal end portion of the sheath 26 (that is, aproximal end portion of the first sheath 36) is faced to an inside ofthe connector receiving portion 25 a. The distal end portion 12 a of thehorn 12 that protrudes from the connector portion 10 a is inserted intothe proximal end portion of the first sheath 36 when the connectorportion 10 a of the ultrasound transducer 5 is connected to theconnector receiving portion 25 a. Here, the distal end portion 12 a ofthe horn 12 is connectable to a proximal end portion of the waveguide 51by screwing or the like, and by the connection, the horn 12 and thewaveguide 51 are connected acoustically and electrically. Thereby,ultrasound vibration that is generated in the ultrasound transducer 11of the ultrasound transducer 5 is transmitted to the waveguide 51, and ahigh-frequency current (drive signal) outputted from the output controlapparatus 6 is transmitted to the waveguide 51.

At a distal end portion of the sheath 26 (that is, the distal endportion of the second sheath 37), a taper portion 37 a in which an outerdiameter is reduced is formed. From a distal end of the taper portion 37a, an ultrasound probe 52 provided at a distal end portion of thewaveguide 51 is protruded. Note that in the present embodiment, theultrasound probe 52 is formed integrally with the waveguide 51 from aconductive metal, and a continuous probe unit 50 is configured by thewaveguide 51 and the ultrasound probe 52.

The ultrasound probe 52 is bent into substantially a shape of a letter“J”. In the present embodiment, the ultrasound probe 52 has a functionas a first electrode section that transmits a high-frequency current toliving tissue, besides a function of transmitting ultrasound vibrationto living tissue.

Here, as a shape of the ultrasound probe 52, an entire region from aproximal end portion to a distal end portion can be formed by being bentalong a single curved line, but in order to secure a region in which asize is controlled with high precision in at least a part of theultrasound probe 52, the ultrasound probe 52 is configured by having astraight-line region halfway therein. Namely, in view of the fact thatworking precision on the occasion of work of a straight-line shape beingperformed is more excellent than working precision on the occasion ofwork of a bent shape being performed, the straight-line region is formedhalfway in the ultrasound probe 52. For example, as shown in FIG. 4, theultrasound probe 52 of the present embodiment is configured by having afirst bent region 52 a that is formed in a region A1, a straight-lineregion 52 b that is formed in a region A2 continuing to the first bentregion 52 a, and a second bent region 52 c that is formed in a region A3at a distal end side and continues to the straight-line region 52 b.Furthermore, in order to allow a degree of freedom of design withrespect to the bent shape as the entire ultrasound probe 52, the firstbent region 52 a and the second bent region 52 c are formed along curvedlines with different curvatures. However, the first bent region 52 a andthe second bent region 52 c may be formed along curved lines with thesame curvature.

The clamp arm 21 is configured by a rod-shaped member formed by a pairof arm members 55 a and 55 b that are laterally divided being joined toeach other by snap-fitting, press-fitting, bonding, adhesion, welding,press-fitting or mechanical means. Concave portions 56 a and 56 b thatface each other are provided halfway in the arm members 55 a and 55 b,and by the concave portions 56 a and 56 b, an opening 56 that extends ina longitudinal direction of the clamp arm 21 is formed halfway in theclamp arm 21. A distal end side of the sheath 26 is inserted through theopening 56, and an inner surface side of the opening 56 and an outersurface side of the sheath 26 are connected via the shaft portion 22,whereby the clamp arm 21 is pivotally supported swingably (rotatably)with respect to the treatment instrument main body 20.

A second finger rest portion 58 that is paired with the first fingerrest portion 28 that is provided at the treatment instrument main body20 is connectively provided at a proximal end portion of the clamp arm21. The second finger rest portion 58 is configured by a ring shape thatis favorable for insertion of a thumb of a surgeon or the like beingformed, for example. For example, the surgeon or the like causes thefinger inserted into the first finger rest portion 28 (for example, thering finger and the fifth finger) and the finger inserted into thesecond finger rest portion 58 (for example, the thumb) to actrelatively, and thereby the clamp arm 21 is caused to act swingably withthe shaft portion 22 as the support point.

A bent portion 59 for avoiding interference with the sheath 26 when theclamp arm 21 is caused to act swingably is provided, at a distal endside of the clamp arm 21 that intersects the treatment instrument mainbody 20 via the shaft portion 22. Further, a base 60 facing theultrasound probe 52 is provided at a distal end side of the bent portion59. The base 60 is provided with a jaw 61 formed from a conductivemetal.

When description is made more specifically, the jaw 61 has a pin hole 62that penetrates therethrough in a width direction, for example, as shownin FIG. 6, and is held by the base 60 via a pin 60 a that is insertedthrough the pin hole 62 (see FIG. 8 to FIG. 13). Namely, the jaw 61 isheld in a swingable state within a predetermined range with the pin 60 aas a center, with respect to the base 60. Thereby, the jaw 61 isdisplaceable between a closed state in which the jaw 61 contacts theultrasound probe 52, and an opened state in which the jaw 61 separatesfrom the ultrasound probe 52 by being linked with swing of the clamp arm21. Note that the jaw 61 has a function as a second electrode section incorrespondence with the ultrasound probe 52 that functions as the firstelectrode section. Note that a shape of the jaw is not limited to theillustrated example as a matter of course.

A region where the jaw 61 and the ultrasound probe 52 displace to becontactable and separable (openable and closable) configures a treatmentsection 63 that is an effective region for performing various kinds oftreatment such as dissection, ablation, and coagulation on livingtissue. A region from a proximal end portion of the jaw 61 to the shaftportion 22 is a treatment incapable region 64 which is incapable ofperforming various kinds of treatment on living tissue.

Here, the jaw 61 is bent into substantially the shape of a letter “J”which is symmetrical with the ultrasound probe 52, as shown in FIG. 5,for example. Namely, the jaw 61 is configured by having a first bentregion 61 a formed in a region A1 at a proximal portion side, astraight-line region 61 b formed in a region A2 continuing to the firstbent region 61 a, and a second bent region 61 c formed in a region A3 ata distal end side continuing to the straight-line region 61 b, similarlyto the ultrasound probe 52. Further, in order to allow the degree offreedom in design for the bent shape as the entire jaw 61, the firstbent region 61 a and the second bent region 61 c are formed along curvedlines with different curvatures. However, the first bent region 61 a andthe second bent region 61 c may be formed along curved lines with thesame curvature.

Further, for example, as shown in FIG. 7, in the jaw 61, inclinedsurfaces 65 that are inclined at predetermined depression angles towarda central portion from respective side edge portions are formed on anopposing surface to the ultrasound probe 52. Further, in the jaw 61, aconcave groove 66 that extends in a longitudinal direction is providedon a bottom portion of the inclined surface 65 that is the opposingsurface to the ultrasound probe 52. In the concave groove 66, a heatinsulating member 67 of a resin, for example, is provided. Further, inthe concave groove 66, a pad 68 formed from a resin material such asTeflon (registered trade name), for example, is provided on a top layerof the heat insulating member 67. The pad 68 has a surface exposed fromthe concave groove 66 set as a contact surface with the ultrasound probe52.

Further, for example, as shown in FIGS. 5 and 6, teeth 69 for slip proofeach formed into a shape of a sawtooth are formed at the respective sideedge portions of the jaw 61 by cutting or the like. Here, if cutting ofthe respective teeth 69 is performed from the same direction to the jaw61 that is formed into the bent shape, teeth heights of the respectiveteeth 69 become uneven. Therefore, in the present embodiment, in orderto even out the teeth heights of the respective teeth 69 into apredetermined range, the respective teeth 69 are formed by cutting thatdiffers for each of the regions 61 a to 61 c. Namely, for example, asshown by the dashed lines in FIG. 5, the respective teeth 69 formed inthe first bent region 61 a is formed by cutting being performed in astate in which a tool is set in a direction perpendicular to the firstbent region 61 a (perpendicular direction from a center point P1 of acircular arc). Further, the respective teeth 69 formed in thestraight-line region 61 b are formed by cutting being performed in astate in which the tool is set at a predetermined angle with respect tothe straight-line region 61 b. Further, the respective teeth 69 formedin the second bent region 61 c are formed by cutting being performed ina state in which the tool is set in a direction perpendicular to thesecond bent region 61 c (perpendicular direction from a center point P2of a circular arc).

In the treatment instrument 7 that is configured as above, plate-shapedstoppers 70 that extend to be directed to side portions of the clamp arm21 from proximal end portion both sides of the ultrasound probe 52 andare each formed into a substantially rectangular shape in side view areprovided at the distal end portion of the treatment instrument main body20 (that is, the distal end portion of the second sheath 37), as shownin FIG. 8 to FIG. 13, for example. The stoppers 70 are for restrictingentry of a living body to a gap of the second sheath 37 and the clamparm 21 between the proximal end portion of the jaw 61 and the shaftportion 22. Namely, as shown in FIGS. 8 and 10, for example, when thejaw 61 is in an opened state, the stoppers 70 are extended from aproximal portion of the ultrasound probe 52 to a directly rear side ofthe jaw 61, and restricts entry of the living body into the treatmentincapable region 64.

For example, as shown in FIGS. 11 and 14 to 16, the respective stoppers70 are held by the sheath 26 via a cylindrical member 71 held in thesecond sheath 37.

When description is made more specifically, a concave portion 37 b forholding the cylindrical member 71 is formed on a distal end portioninner periphery of the second sheath 37, as shown in FIG. 11, forexample. A proximal end portion of the cylindrical member 71 in a statein which the ultrasound probe 52 is inserted therethrough is held in theconcave portion 37 b. Namely, as illustrated, a step portion 71 a isformed at the proximal end portion of the cylindrical member 71, and thestep portion 71 a is engaged in the concave portion 37 b, whereby thecylindrical member 71 is prevented from dropping off from the secondsheath 37. Further, a protruding portion 71 b is formed at a properplace on the step portion 71 a of the cylindrical member 71, and theprotruding portion 71 b is engaged in an inside of the concave portion37 b, whereby rotation of the cylindrical member 71 relative to thesecond sheath 37 is prevented.

At both sides of the proximal end portion of the ultrasound probe 52,the respective stoppers 70 are linearly extended to be directed to thesides of the clamp arm 21 that are at a proximal end side of the jaw 61from a distal end portion of the cylindrical member 71. In this case,the respective stoppers 70 are set so that edge portions at distal endsides thereof are always located at a distal end side with respect to alocus of movement of the proximal end portion of the jaw 61 followingswing of the clamp arm 21. In other words, the respective stoppers 70are set so as to be always superimposed from the sides onto the proximalend portion of the jaw 61 while the jaw 61 moves, for example, from theclosed position shown in FIG. 9 to the opened position shown in FIG. 8by swing of the clamp arm 21. Further, as shown in FIGS. 9, 12 and 13,for example, lengths of the respective stoppers 70 are each preferablyset at a length within a range in which an extension end portion of thestopper 70 does not protrude from a back surface of the clamp arm 21(that is, a surface on a side that does not face the treatmentinstrument main body 20, of the clamp arm 21) when the jaw 61 is in theclosed state. Further, clearances of the respective stoppers 70 withrespect to the clamp arm 21 are desirably set to be as small as possiblewithin a range without inhibiting swing of the clamp arm 21.

Further, from a distal end portion of the cylindrical member 71, a probecover 72 that faces the ultrasound probe 52 is extendedly provided. Theprobe cover 72 is configured by a scoop-shaped member that is located atan opposite side from the jaw 61, and covers a predetermined range ofthe proximal portion side of the ultrasound probe 52. In the presentembodiment, the probe cover 72 is bent to follow a bent shape of theultrasound probe 52 (see, for example, FIG. 15), and is configured tocover the first bent region 52 a in a position separated at apredetermined space from the ultrasound probe 52, for example. The rangeto be covered may be a whole of the ultrasound probe 52, or a partialregion of the ultrasound probe 52.

When treatment on living tissue is performed with use of the treatmentinstrument 7 as above, a surgeon or the like causes the jaw 61 toperform opening and closing action with respect to the ultrasound probe52 (that is, cause the treatment section 63 to perform opening andclosing action) through operation to the first and the second fingerrest portions 28 and 58 that are the operation portions, and sandwichesthe living tissue between the ultrasound probe 52 and the pad 68 of thejaw 61. In the state, the surgeon or the like operates the foot switch17, the switch button 29, or the like, and transmits at least any one ofultrasound vibration and a high-frequency current to the living tissuefrom the ultrasound probe 52. Thereby, treatment such as dissection,ablation, or coagulation is performed on the living tissue.

On the occasion, even when the jaw 61 is in the opened state withrespect to the ultrasound probe 52 (even when the treatment section 63is in the opened state), entry of the living tissue into the treatmentincapable region 64 at the proximal portion side from the jaw 61 isrestricted by the stoppers 70 that are across the rear side of theopened treatment section 63. Further, the stoppers 70 are set so thatthe edge portions at the distal end sides thereof are located at thedistal end side from the locus of the proximal end of the jaw 61following displacement of the base 60, and thereby simultaneouslyrestrict entry of the living tissue into a gap between the base 60 andthe proximal end portion of the jaw 61. Thereby, the treatmentinstrument 7 can sandwich the living tissue by only the treatmentsection 63 between the ultrasound probe 52 and the jaw 61. Accordingly,the surgeon or the like can perform quick and appropriate treatment onthe living tissue by the treatment section 63, and can immediatelyrecognize completion when the treatment is completed. Namely,transmission of an erroneous sense that the treatment is stillcontinuing to the hand of the surgeon even after completion of thetreatment on the living tissue by the treatment section 63 by the livingtissue being sandwiched in the treatment incapable region 64 can beappropriately prevented. Accordingly, the surgeon or the like canimmediately stop the output of the ultrasound vibration or the likeafter the treatment on the living tissue is completed, prevents the pad68 from being excessively worn by the ultrasound vibration or the like,and can realize extension of the life of the pad 68. Thereby, themalfunction of the metallic portions of the probe 52 and the jaw 61directly contacting each other or the like can be avoided.

In this case, in particular, the edge portion at the distal end side ofthe stopper 70 is set to be located at the distal end side from thelocus of movement of the proximal end of the jaw 61, and thereby, thefunction of restricting entry of the living tissue into the treatmentincapable region 64, and the function of restricting entry of a livingbody into the gap between the base 60 and the proximal end portion ofthe jaw 61 can be simultaneously realized by the simple configuration inwhich only the stoppers 70 are provided.

Further, the clearances with respect to the side portions of the clamparm 21, of the respective stoppers 70 are properly set, whereby therespective stoppers 70 can be also caused to function as guide memberson the occasion of the clamp arm 21 swinging, and the malfunction of thejaw 61 being offset in the lateral direction with respect to theultrasound probe 52 on the occasion of sandwiching living tissue or thelike can be eliminated. Namely, in order to cause the clamp arm 21 toswing smoothly with respect to the treatment instrument main body 20, apredetermined play needs to be given to the shaft portion 22, and whensuch a play is given, occurrence of backlash or the like on the occasionof swing of the clamp arm 21 can be suppressed by the respectivestoppers 70 being caused to function as the guide members.

Further, the lengths of the stoppers 70 are each set at the lengthwithin the range in which the extension end portion does not protrudefrom the back surface side of the clamp arm 21 when the jaw 61 is in theclosed state, and thereby, reduction in operability can be preventedeven when the stoppers 70 are provided at the treatment instrument 7.However, when priority is given to prevention of entry of tissue intothe non-treatment region, when the opening amount between the jaw andthe probe is made large, the design of the extension end portion toprotrude from the back surface side of the clamp arm 21 may be made.

Further, the straight-line regions 52 b and 61 b are provided halfway inthe ultrasound probe 52 and the jaw 61, and thereby, the regions inwhich sufficient size control is performed for the clearance or the likeof the ultrasound probe 52 and the inclined surfaces 65 of the jaw 61can be formed, halfway in the treatment section 63 which forms a bentshape as a whole. Living tissue such as a blood vessel is sandwiched inthe straight-line regions 52 b and 61 b in which sufficient size controlis performed like this, and thereby treatment such as blood vesselsealing can be realized stably.

Further, the heat insulating member 67 is caused to lie on a lower layerof the pad 68 placed in the concave groove 66 that is formed in the jaw61, and thereby the heat generated in the pad 68 by ultrasound vibrationcan be prevented from being directly transmitted to the back surfaceside of the jaw 61.

Further, the proximal portion side of the ultrasound probe 52 is coveredwith the probe cover 72, and thereby even in the case of the surgeon orthe like performing treatment with attention focused on the distal endside of the ultrasound probe 52 or the like, unintentional contact ofthe proximal portion side of the ultrasound probe 52 with thetemperature raised by the ultrasound vibration and living tissue can beavoided. In this case, the probe cover 72 is integrally formed on thecylindrical member 71 that holds the stoppers 70, and thereby the probecover 72 can be configured by a simple configuration without increase ofthe number of components. Further, for example, if the probe cover 72 isprovided restrictively to correspond to the first bent region 52 a,interference of the probe cover 72 with living tissue can be avoided atthe time of treatment such as blood vessel sealing with use of thestraight-line region 52 b. However, the range that is covered may be thewhole of the ultrasound probe 52 or a partial region of the ultrasoundprobe 52.

Further, on the occasion of formation of the teeth 69 for slip proof atthe respective side edge portions of the jaw 61, the tool is set in thedirections perpendicular respectively to the circular arcs of therespective bent regions 61 a and 61 c at the time of cutting for thefirst and the second bent regions 61 a and 61 c, and thereby, the teethheights of the respective teeth 69 can be evened out.

Note that in the aforementioned embodiment, various modifications andchanges can be made. For example, in the aforementioned embodiment, oneexample in which the stoppers 70 are extendedly provided linearly to bedirected to the sides of the clamp arm 21 from the sides of theultrasound probe 52 is described, but the present invention is notlimited thereto, and, for example, as shown in FIG. 17, the stoppers 70also can be each extendedly provided in the circular-arc shape.

Further, in the aforementioned embodiment, one example in which the pairof stoppers 70 are placed at both the sides of the ultrasound probe 52is described, but the present invention is not limited to this, and, forexample, as shown in FIG. 18, the stopper 70 also can be provided atonly one side of the ultrasound probe.

Further, in the aforementioned embodiment, one example in which thestoppers 70 are extendedly provided to be directed to the clamp arm 21side from the treatment instrument main body 20 side is described, butthe present invention is not limited thereto, and, for example, as shownin FIG. 19, the stoppers 70 also can be extendedly provided to bedirected to the treatment instrument main body 20 side from the clamparm 21 side.

Next, with reference to FIG. 20 to FIG. 24, a second embodiment of thepresent invention will be described. Note that the present embodimentmainly differs from the aforementioned first embodiment in the point inwhich the configuration of the stopper is changed, the point in whichauxiliary stoppers are provided at a base side, and the point in whichthe probe cover is abolished. Besides, the same components as in theaforementioned first embodiment will be assigned with the same referencesigns and the description thereof will be omitted.

As shown in FIG. 20 to FIG. 24, respective stoppers 80 of the presentembodiment are configured by metallic members integrally formed atdistal end portions of respective left and right sheath members 42 a and42 b that configure the second sheath 37. The stoppers 80 are formedintegrally with the sheath members 42 a and 42 b and made of a metallike this, and thereby as compared with the case of the stoppers beingconfigured by a resin or the like, rigidity of the respective stoppers80 is enhanced.

The respective stoppers 80 are each formed by being bent into acircular-arc shape, and are more specifically formed into a circular-arcshape with the shaft portion 22 that pivotally supports the clamp arm 21at the treatment instrument main body 20 in the present embodiment.Thereby, as compared with, for example, the case in which the stoppersare extendedly provided linearly (virtually expressed by the dashed lineby being assigned with reference sign 80 i in FIG. 21), the extensionend portions of the stoppers 80 can be offset to the proximal end sideof the treatment instrument 7. Accordingly, even when the lengths of therespective stoppers 80 are set to be long so as to cause the respectivestoppers 80 to function effectively even in a state in which the jaw 61is opened to a relatively large opening degree with respect to theultrasound probe 52, for example, the stoppers 80 can be restrained fromhindering treatment. Namely, even when the stoppers 80 are set to belong so that the extension end portions of the stoppers 80 protrude fromback surface of the clamp arm 21 (that is, a surface at the side thatdoes not face the treatment instrument main body 20 of the clamp arm21), the extension end portions of the protruded stoppers 80 are offsetto the proximal end side from the treatment section 63, and therefore,the extension end portions of the stoppers 80 can be prevented frominterfering with living tissue or the like. In addition, when thestoppers 80 are bent, the extension end portions of the stoppers 80 canbe caused to be close to the shaft portion 22 side as compared with thecase in which the stoppers are each formed into a straight-line shape,and therefore, even when the stoppers are caused to function withrespect to the same opening degree of the probe 61, the entry preventingfunction for living tissue can be realized with shorter extensionlengths.

Further, for example, as shown in FIG. 22, an edge portion 80 a at adistal end side of the stopper 80 is set to be located at a distal endside from a locus L of the proximal end of the jaw 61 following themovement of the base 60. Thereby, the respective stoppers 80 are set tobe always superimposed onto the proximal end portion of the jaw 61 fromthe sides while the jaw 61 moves from a closed position shown in FIG.21, for example, to an opened position shown in FIG. 20 by swing of theclamp arm 21. Accordingly, by the simple configuration in which only thestoppers 80 are provided, the function of restricting entry of livingtissue into the treatment incapable region 64, and the function ofrestricting entry of a living body into a gap between the base 60 andthe proximal end portion of the jaw 61 can be simultaneously realized.

Further, auxiliary stoppers 81 that face side portions at the proximalend side of the jaw 61 are provided protrudingly from the base 60 of thepresent embodiment. In the present embodiment, the auxiliary stopper 81is provided at a position adjacent to the stopper 80 in a distal endside from the stopper 80 in order to prevent interference with thestopper 80. Further, a height of the auxiliary stopper 81 is set to behigher than the gap from the base 60 at the proximal end side of the jaw61 and lower than the jaw 61. By providing the auxiliary stopper 81 likethis, even when the jaw 61 is opened to a vicinity of a fully openedposition that is not assumed in normal use, and the extension stepportion of the stopper 80 is located at the probe 52 side from the jaw61 as shown in FIG. 23, for example, living tissue can be prevented fromentering the gap between the base 60 and the proximal end side of thejaw 61.

Note that the present invention is not limited to the respectiveembodiments described above, and various modifications and changes canbe made. Such various modifications and changes are also within thetechnical range of the present invention. For example, theconfigurations described in the aforementioned respective embodiments,and the respective modifications thereof and the like may be properlycombined as a matter of course.

What is claimed is:
 1. An ultrasound treatment instrument, comprising:an ultrasound probe that transmits ultrasound vibration: a treatmentsection provided at a distal end portion of the ultrasound probe, fortreating a subject with the ultrasound vibration; a jaw that is arrangedto be opposed to the treatment section; a sheath through which theultrasound probe is inserted; a base connected to the sheath via a shaftportion, the base swingably supporting the jaw so as to have a spacebetween the base and the jaw; operation portions that cause the base topivot around the shaft portion such that the jaw moves between a closedstate in which the jaw is proximate to the treatment section and anopened state in which the jaw is distanced from the treatment section;and stoppers formed in an arc shape in order to cover a space between aproximal portion of the jaw and the base.
 2. The ultrasound treatmentinstrument according to claim 1, wherein the stoppers are positioned ona distal end side with respect to a locus drawn by the proximal portionwhen the operation portions are operated from the closed state to theopened state, and the stoppers are formed in an arc shape with the shaftportion positioned at the center in order to be extended in an arc shapefrom a side of the sheath to a side of the base along the locus drawn bythe jaw.
 3. The ultrasound treatment instrument according to claim 1,wherein the stoppers are formed in an arc shape along a locus drawn bythe proximal portion of the jaw.
 4. The ultrasound treatment instrumentaccording to claim 1, wherein edge portions at distal end sides of thestoppers are located on a distal end side with respect to a locus drawnby the proximal portion of the jaw.
 5. The ultrasound treatmentinstrument according to claim 1, wherein the operation portions areoperated in an opening and closing direction so as to move between theclosed state and the opened state, and the stoppers cover the space thatis positioned between the proximal portion of the jaw and the base inthe opening and closing direction.
 6. The ultrasound treatmentinstrument according to claim 1, further comprising a pin thatpenetrates the jaw, wherein the probe extends in the longitudinaldirection, the base includes a first hole through which the pinpenetrates, the jaw includes a second hole that extends in a widthdirection perpendicular to the longitudinal direction and thatpenetrates the pin, and the base supports the jaw such that the jaw canswing around the pin.
 7. The ultrasound treatment instrument accordingto claim 1, wherein the stoppers extend in a pair from both sides of thesheath, and also serves to function as guide members when the jawoperates to open and close with respect to the treatment section.
 8. Theultrasound treatment instrument according to claim 1, wherein thestoppers each have a length that is set within a range that the stopperdoes not protrude from a surface on a side of the base which is notopposed to the sheath when the jaw is in the closed state.